I have been a type 1 for 32 years and I know how much BG spikes if I eat certain foods or snacks. A CGM is definately not for everyone and people in the mechanical and trades occupations would probably continuously break them or get infections. I don't use one and my doctor told me that type 1s with A1cs lower than 6.0 is real risky. The ADA says that 7.0 or less is acceptable and 6.5 or less is excellent and I am happy with my control. If I stay on my diet and eat at specific times, I can't remember the last time I was sick and had to test more often.
Different strokes for different folks. My dog is diabetic and the last visit to the vet her A1c was 6.9 and that is using lantus only.
I have to disagree w/ the doc here. When my A1C drifted higher, my BG was flying all over the place. A CGM isn't bulletproof but I think that it opens things up in terms of activities, food and getting things to run more smoothly. I find my doses of both basal and bolus drift every few months, maybe recently because of the seasons but a 10% adjustment got me back to running flat all the time. There's times where the CGM telemetry gets out of whack, but when it's on, it would be extremely useful to someone in a mechanical occupation as they could check their BG by looking at their pump, at least w/ the MiniMed system, where you only have one gizmo. If you use enough of the right kind of tape (FlexFix Opsite tape...) they are stuck down pretty well too. I did ok when my pump blew up, going back to NPH for 3 days, but I wasn't as confident in my readings. Admittedly, it was the 4th of July and I didn't let a pesky pump malfunction get in the way of some whoopin' and hollerin'...heh heh heh...
I agree with AR. Although I agree with you that a CGMS is not for everyone - some people get too obsessed with the data. I disagree about the infections. There are a lot of people that wear their Dex sensors for 3 weeks and never have problems. Dex only recommends 7 days but most people do longer. I often hear about people having infections at pump sites but rarely hear about them with a Dexcom site.
The American Association of Clinical Endocrinologists actually recommends an A1c of less than 6.5. They state on their website that the closer one can get to normal, the less chances of complications. If you have followed any of the Joslin medalist studies, you would see that a lot of it has more to do with your genes than your A1c. I know a bunch of people that ended up with complications after having A1cs in the 6s.
Most people that opt for tight control pretty much dismiss anything recommended by the ADA. Their programs really do nothing to help diabetics and do more harm than good. Dr. Bernstein is a diabetic himself and he thinks an A1c of 6.0 is too high. Being someone with complications, I wish I had heard of Dr. Bernstein 28 years ago.
Hmmm, I'm not sure I look at what the ADA says however I think that they do ok being a public voice and funnel into which donations can be channeled, funds raised, etc. The whole guidelines issue is hamstrung by the AMA not taking a more agressive stance and overall fear of hypos that keeps people from pushing the envelope. I don't think that the ADA can "trump" doctors' advice on those sort of issues?
But the AACE is made up of doctors and they think an A1c should be below 6.5 - that is a lot better than the ADA's 7.0. I don't think they are getting in trouble with doctors when doctors recommend lower than what they do. They do seem to raise money but I can't really say they put that money to good use.
I wasn't saying that a CGM is right for everyone. What I was saying is that unless you test 50 or more times a day you really have no idea of what your blood sugars are doing. 4 or 5 tests a day for a type 1 is very old school, although it may be perfect for you. Once you put a CGM on, it is like having your eyes opened up for the first time and REALLY knowing what is going on between those tests. You can go to bed with one number and wake up almost the same number, but could have many highs and lows during that time which will still give you a decent A1c.
Plus I have seen a lot of people that thought certain foods did not spike them and once they put a CGMS on and saw those arrows going straight up, they realized what those supposedly good foods did to them.
I guess if type 1s test between 10-18 times a day then there should be no need for an A1c test.
4-5 tests a day for type 1 diabetics is old school, that has me scratching my head. My best friend is a type 1 (5 years) and he works for the Polk County sheriff's office....he has United Healthcare insurance and they sure don't allow 10+ test strips a day. He has excellent insurance and he gets 200 strips per month and his A1cs run 6.5.....the most UHC will allow per month is 300 and that is for intitially getting the newly diagnosed patient under control, after that 200 per month. Government jobs offer the best health insurance.
I just find it nuts to test more than 6 times a day inless the person is ill or newly diagnosed.....that's just letting diabetes take over your life.
Being a type 1 for over 30 years does qualify me as someone who knows what they are doing. I was a diabetic LONG before portable BG meters were invented.
I would love to know what insurance companies allow 10-18 strips per day, that is a boat load and at $60-$75 per box of fifty. let's take the type 1s who claim to test 12 times per day.....that's over $6000 a year just on strips.
If testing 4-5 times daily makes me old school in this crazy world, it works for me.
Anyone that is hypo unaware can easily get an insurance override with a doctor's help. We have had several different insurance companies over the years and so has my son. Not a problem. Many children also need to be tested a lot because they cannot tell whether they are high or low. Also not a problem for a ped endo to write the medical necessity letter or simply write the script. I disagree completely that testing often is letting diabetes take over your life. It's actually the opposite in my opinion.
Most doctors will still do an A1c test regardless of how many times someone tests because that is what they want to see. There are a lot of people that forge their readings so why would a doctor trust someone to be honest with their readings? I certainly would not take someone’s word on it when I know what people do.
As far your cost, your pricing is a little on the high side. I use AccuChek Aviva test strips and American Diabetes Wholesale sells those to anyone that wants them for $36 for a box of 50. My insurance company pays my supplier $33 a box. That costs them a little less than $4,400 a year and that is for my testing 18 times a day.
I know a lot of people that do the same thing 10 different times and get 10 different results. That has nothing to do with whether they know what they are doing or not. A lot of those same people get A1cs in the 5s so I would say they must know a thing or two about what they are doing. There are so many things besides food that it affect your BS it is insane to say that you don’t need to test because you know what you are doing. My meter has told me several times before I even felt sick that something was not right because my BS went up all of a sudden. My basals change when the weather changes. Women have hormone problems. Stress can impact your BS.
Six times a day is not enough, especially if you drive your car to work. You should be testing every time you get behind the wheel. Even if you go to work and stay in at lunchtime, that is 2 times right there plus 3 for meals and once before bed. That is 6 right there without testing if you feel low or anything else that can happen.
Like Mary said, your friend could appeal his insurance companies policy and would most likely win. Insurance companies put the limits on because of all the people that get the strips and then sell them on eBay. That doesn’t mean that if you actually need them, you can’t get them.
I test about 160 test strip..I check 5 or 6 times a day...I check in the morning when i wake up, after each meal, bedtime and around 3am....sometime if i eat something new, i test to see how it affect my sugar.....
The Diabetes Hands Foundation and Diabetes Advocates Program is proud to announce and congratulate the members of DA who were granted scholarships to attend diabetes conferences in 2013! Thanks to a generous grant from Novo Nordisk, in 2013 we were … Continue Reading
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